Intraoperative CT verification of electrode localization in DBS surgery in Parkinson's disease

•Accurate placement of electrodes in DBS surgery is essential for good outcome.•Verification of their position can be performed by CT in the operating room.•This CT eliminates the neccessity of post-op evaluation outside the operating room.•Reposition can be done during one procedure.

BackgroundPrecise and accurate placement of electrodes in DBS surgery is essential in achievement of proper therapeutical effect in movement disorders. Verification of their position in the target is necessary. It can be performed postoperatively. But more convenient for the patient is an intraoperative CT imaging in the operating room. We evaluated the results of DBS electrodes implantation in patients with Parkinson's disease by intraoperative CT.Case series21 patients with Parkinson's disease were operated in 2010–2012 in the Military Clinical Hospital in Bydgoszcz, Poland. Standard procedure of electrode implantation was verified by intraoperative CT in operating room. CT scans were fused with preoperative MRI plan of target (STN) and trajectory and accuracy were assessed.ResultsMean differences between positions of tips of electrodes implanted and intended coordinates of targets were: 0.9 mm; 1.6 mm; and 0.8 mm in horizontal line, in vertical line, and in lateral line respectively and remain within the limits of the intraoperative CT resolution. In 1 case the accuracy was not satisfying and replacement of electrodes in one stage surgery was required.ConclusionsIntraoperative CT is a helpful tool in DBS procedures and enables comparison of preoperative plans with the final trajectory and localization of the tip of electrode visualized in CT in appropriate target. It eliminates necessity of post-op verification outside the operating room. All changes can be done during the procedure. It also allows to rule out the intracerebral haematoma caused by implantation.